The researchers investigated the use of pretransplantation imaging techniques to detect focal lesions in cirrhotic patients.
Focal lesions detected by imaging examinations during pretransplantation evaluation were correlated with focal lesions detected during detailed pathological examination of 49 cirrhotic explant livers.
The findings of the study were published in the September issue of Liver Transplantation.
Within 6 months before transplantation, 3 types of imaging examinations were conducted.
These were color Doppler ultrasonography (US), contrast-enhanced computed tomography (CT), and
magnetic resonance (MR) imaging, and were performed in 94%, 33%, and 55% of patients, respectively.
In 2% to 8% of patients, different types of benign focal lesions were present. A considerable proportion was interpreted as premalignant or malignant on imaging examination.
| Contrast-enhanced MR examination is best for detecting malignancies early.
| Liver Transplantation |
US detected only the largest hepatocellular carcinomas (patient sensitivity, 40%; specificity, 100%) and no dysplastic nodules.
On a per-patient basis, contrast-enhanced CT and MR imaging had poor sensitivity (20% and 27%, respectively) and good specificity (100% and 94%, respectively) for dysplastic nodules.
Patient sensitivity and specificity of both techniques for hepatocellular carcinoma were reasonable (50% for CT, 70% for MR imaging) and good (79% for CT, 82% for MR imaging), respectively.
However, the authors found that neither technique was able to detect smaller premalignant or malignant lesions.
As a consequence, 10% of patients underwent transplantation, although they exceeded the tumor number limit.
Louis Libbrecht, of the University of Leuven, said on behalf of his group, "Currently-used imaging techniques cannot correctly determine the exact tumor burden in some cirrhotic patients."
"Regular contrast-enhanced MR examination of cirrhotic patients waiting for liver transplantation is the best tool for the early detection of premalignant or malignant lesions," he concluded.